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Schmid AA, Van Puymbroeck M, Altenburger PA, Miller KK, Combs SA, Page SJ. Balance is associated with quality of life in chronic stroke. Top Stroke Rehabil 2013; 20:340-6. [PMID: 23893833 DOI: 10.1310/tsr2004-340] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment. METHODS This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported. RESULTS Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001). CONCLUSION In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.
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Affiliation(s)
- Arlene A Schmid
- Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center on Implementing Evidence-Based Practice, Indianapolis, IN, USA
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Verma R, Arya KN, Garg RK, Singh T. Task-oriented circuit class training program with motor imagery for gait rehabilitation in poststroke patients: a randomized controlled trial. Top Stroke Rehabil 2012; 18 Suppl 1:620-32. [PMID: 22120031 DOI: 10.1310/tsr18s01-620] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The ability to walk is impaired in more than 80% of poststroke patients. The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training (TOCCT) with motor imagery (MI) on the gait during the subacute phase after a stroke. METHOD This was a randomized, controlled, assessor-blinded trial in a neurology department of a university hospital. A convenience sample of 30 people, 4 to 12 weeks (mean, 6.3 weeks) after the stroke was randomized into 2 groups (the TOCCT with MI and standard training group) of 15 people each. Twenty-nine participants completed the 6-week follow-up. Participants were assigned to receive either the TOCCT with MI or dose-matched standard training program based on the Bobath's neurodevelopmental technique, 7 days a week for 2 weeks, as outpatients or inpatients. Outcome measures were the Functional Ambulation Classification (FAC), the Rivermead Visual Gait Assessment (RVGA), step length asymmetry, walking speed, and 6-minute walk test (6MWT). RESULTS The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessments in comparison to the control group. However, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC, RVGA, walking speed, and 6MWT (ANOVA, P = .001 to .049; Mann-Whitney U test, P = .001). CONCLUSION Among the patients who had a stroke within the previous 4 to 12 weeks, the TOCCT with MI produced statistically significant and clinically relevant improvements in the gait and the gait-related activities.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, CSM Medical University, Lucknow, India
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Hillier S, English C, Crotty M, Segal L, Bernhardt J, Esterman A. Circuit Class or Seven-Day Therapy for Increasing Intensity of Rehabilitation after Stroke: Protocol of the CIRCIT Trial. Int J Stroke 2011; 6:560-5. [DOI: 10.1111/j.1747-4949.2011.00686.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale There is strong evidence for a dose–response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. Aims To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Design Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. Study A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40–80 points or motor 38–62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. Outcomes The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction.
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Affiliation(s)
- Susan Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Coralie English
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, Adelaide, SA, Australia
| | - Leonie Segal
- Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Julie Bernhardt
- National Stroke Research Institute (Florey Neuroscience Institute), Adelaide, SA, Australia
| | - Adrian Esterman
- Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
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Barfield J. Commentaries. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J.P. Barfield
- Department of EXPW, Tennessee Tech University, Cookeville, TN, USA Research Associate, Lakeshore Foundation, Birmingham, AL, USA
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Lynch EA, Watson SC. Is circuit class physiotherapy possible during inpatient spinal cord injury rehabilitation? A feasibility trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elizabeth A Lynch, Sarah C Watson Aims: This article describes a feasibility study to determine whether circuit classes could be successfully provided to patients with recently acquired spinal cord injury (SCI) undergoing inpatient rehabilitation. Methods: Eleven patients with SCI participated in a physiotherapy circuit class run in addition to regular inpatient rehabilitation, over a two month period. All patients chose to attend the circuit classes for the duration of their availability. On completion of the trial, a purpose-designed questionnaire was administered to investigate patient satisfaction. Feedback was also collected from staff regarding their experience of the circuit class. Findings: No adverse events occurred during any circuit classes. Patients reported high levels of satisfaction with the class, reporting that classes were challenging, motivating, confidence building and a source of peer-support. Staff reported that circuit classes helped build clinical skills and confidence, and allowed the provision of effective therapy to SCI patients. All patients and staff recommended that circuit classes continue. Conclusions: This small feasibility study demonstrated that it is both possible and desirable to implement circuit class physiotherapy to a cohort of people with recently acquired SCI undergoing inpatient rehabilitation.
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The effect of balance training on balance performance in individuals poststroke: a systematic review. J Neurol Phys Ther 2010; 34:127-37. [PMID: 20716987 DOI: 10.1097/npt.0b013e3181ef764d] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of long-term disability, and impaired balance after stroke is strongly associated with future function and recovery. Until recently there has been limited evidence to support the use of balance training to improve balance performance in this population. Information about the optimum exercise dosage has also been lacking. This review evaluated recent evidence related to the effect of balance training on balance performance among individuals poststroke across the continuum of recovery. On the basis of this evidence, we also provide recommendations for exercise prescription in such programs. METHODS A systematic search was performed on literature published between January 2006 and February 2010, using multiple combinations of intervention (eg, "exercise"), population (eg, "stroke"), and outcome (eg, "balance"). Criteria for inclusion of a study was having at least 1 standing balance exercise in the intervention and 1 study outcome to evaluate balance. RESULTS Twenty-two published studies met the inclusion criteria. We found moderate evidence that balance performance can be improved following individual, "one-on-one" balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke. Moderate evidence also suggests that in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive. DISCUSSION AND CONCLUSIONS This review supports the use of balance training exercises to improve balance performance for individuals with moderately severe stroke. Future high-quality, controlled studies should investigate the effects of balance training for individuals poststroke who have severe impairment, additional complications/comorbidities, or specific balance lesions (eg, cerebellar or vestibular). Optimal training dosage should also be further explored. Studies with long-term follow-up are needed to assess outcomes related to participation in the community and reduction of fall risk.
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Rose D, Paris T, Crews E, Wu SS, Sun A, Behrman AL, Duncan P. Feasibility and effectiveness of circuit training in acute stroke rehabilitation. Neurorehabil Neural Repair 2010; 25:140-8. [PMID: 21051764 DOI: 10.1177/1545968310384270] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation. OBJECTIVE To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient stroke unit. METHODS Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. RESULTS The CTPT model was successfully implemented in an acute rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group (0.21 ± 0.25 m/sec vs. 0.13 ± 0.22 m/sec; p = 0.03). The difference between groups occurred primarily among those who were ambulatory upon admission. There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM, SF-36 and living location. CONCLUSIONS Therapy focused on systematically progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program. This circuit-training model resulted in greater gains in gait velocity over the course of inpatient rehabilitation compared to the standard model of care. Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care.
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Affiliation(s)
- Dorian Rose
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Outermans JC, van Peppen RPS, Wittink H, Takken T, Kwakkel G. Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study. Clin Rehabil 2010; 24:979-87. [PMID: 20719820 DOI: 10.1177/0269215509360647] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the feasibility and the effects on gait of a high intensity task-oriented training, incorporating a high cardiovascular workload and large number of repetitions, in patients with subacute stroke, when compared to a low intensity physiotherapy-programme. DESIGN AND SUBJECTS Randomized controlled clinical trial: Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset. MEASURES Maximal gait speed assessed with the 10-metre timed walking test (10MTWT), walking capacity assessed with the six-minute walk test (6MWT). Control of standing balance assessed with the Berg Balance Scale and the Functional Reach test. Group differences were analysed using a Mann-Whitney U-test. RESULTS Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT (Z = -2.13, P = 0.03) and the 6MWT (Z = -2.26, P = 0.02). No between-group difference were found for the Berg Balance Scale (Z = -0.07, P = 0.45) and the Functional Reach test (Z = -0.21, P = 0.84). CONCLUSION A high-intensity task-oriented training programme designed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy-programme in terms of gait speed and walking capacity in patients with subacute stroke. In a future study, it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking.
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Affiliation(s)
- Jacqueline C Outermans
- Department of Physiotherapy, Institute for Human Movement Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands.
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Abstract
BACKGROUND Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practise time without increasing staffing. OBJECTIVES To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), CINAHL (1982 to November 2008) and 14 other electronic databases (to November 2008). We also searched proceedings from relevant conferences, reference lists and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials including people over 18 years old diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed methodological quality and extracted data. MAIN RESULTS We included six trials involving 292 participants. Participants were long-term stroke survivors living in the community or receiving inpatient rehabilitation. All could walk 10 metres with or without assistance. Four studies measured walking capacity and three measured gait speed, demonstrating that CCT was superior to the comparison intervention (Six Minute Walk Test: mean difference (MD), fixed 76.57 metres, 95% confidence interval (CI) 38.44 to 114.70, P < 0.0001; gait speed: MD, fixed 0.12 m/s, 95% CI 0.00 to 0.24, P = 004). Two studies measured balance, showing a superior effect in favour of CCT (Step Test: MD, fixed 3.00 steps, 95% CI 0.08 to 5.91, P = 0.04; activities-specific balance and confidence: MD, fixed 7.76, 95% CI 0.66 to 14.87, P = 0.03). Studies also measured other balance items showing no difference in effect. Length of stay (two studies) showed a significant effect in favour of CCT (MD, fixed -19.73 days, 95% CI -35.43 to -4.04, P = 0.01). Only two studies measured adverse events (falls during therapy): all were minor. AUTHORS' CONCLUSIONS CCT is safe and effective in improving mobility for people after moderate stroke and may reduce inpatient length of stay. Further research is required, investigating quality of life, participation and cost-benefits, that compares CCT to standard care and that also investigates the differential effects of stroke severity, latency and age.
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Affiliation(s)
- Coralie English
- University of South Australia (City East)Centre for Allied Health EvidenceNorth TerraceAdelaideAustralia5000
| | - Susan L Hillier
- University of South Australia (City East)Centre for Allied Health EvidenceNorth TerraceAdelaideAustralia5000
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Lang CE, Macdonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, Hornby TG, Ross SA, Scheets PL. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil 2009; 90:1692-8. [PMID: 19801058 DOI: 10.1016/j.apmr.2009.04.005] [Citation(s) in RCA: 435] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 02/02/2009] [Accepted: 04/09/2009] [Indexed: 11/18/2022]
Abstract
UNLABELLED Lang CE, MacDonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, Hornby TG, Ross SA, Scheets PL. Observation of amounts of movement practice provided during stroke rehabilitation. OBJECTIVE To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided. DESIGN Observational survey of stroke therapy sessions. SETTING Seven inpatient and outpatient rehabilitation sites. PARTICIPANTS We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps. RESULTS Practice of task-specific, functional upper extremity movements occurred in 51% of the sessions that addressed upper limb rehabilitation, and the average number of repetitions/session was 32 (95% confidence interval [CI]=20-44). Practice of gait occurred in 84% of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 (95% CI=296-418). None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories. CONCLUSIONS The amount of practice provided during poststroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally.
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Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University, St. Louis, MO, USA.
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Abstract
BACKGROUND Physical fitness is low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training (cardiorespiratory or strength, or both) after stroke reduces death, dependence and disability. The secondary aims were to determine the effects of fitness training on physical fitness, mobility, physical function, health status and quality of life, mood and incidence of adverse events. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched March 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), CINAHL (1982 to March 2007), and six additional databases to March 2007. We handsearched relevant journals and conference proceedings, and screened bibliographies. We searched trials registers and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials if the aim of the intervention was to improve muscle strength or cardiorespiratory fitness, or both, and if the control groups comprised either no intervention, usual care or a non-exercise intervention. DATA COLLECTION AND ANALYSIS Two review authors determined trial eligibility and quality. One review author extracted outcome data at end of intervention and follow-up scores, or as change from baseline scores. Diverse outcome measures limited the intended analysis. MAIN RESULTS We included 24 trials, involving 1147 participants, comprising cardiorespiratory (11 trials, 692 participants), strength (four trials, 158 participants) and mixed training interventions (nine trials, 360 participants). Death was infrequent at the end of the intervention (1/1147) and follow up (8/627). No dependence data were reported. Diverse disability measures made meta-analysis difficult; the majority of effect sizes were not significant. Cardiorespiratory training involving walking, improved maximum walking speed (mean difference (MD) 6.47 metres per minute, 95% confidence interval (CI) 2.37 to 10.57), walking endurance (MD 38.9 metres per six minutes, 95% CI 14.3 to 63.5), and reduced dependence during walking (Functional Ambulation Categories MD 0.72, 95% CI 0.46 to 0.98). Current data include few strength training trials, and lack non-exercise attention controls, long-term training and follow up. AUTHORS' CONCLUSIONS The effects of training on death, dependence and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training, involving walking, within post-stroke rehabilitation in order to improve speed, tolerance and independence during walking. Further trials are needed to determine the optimal exercise prescription after stroke and identify any long-term benefits.
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Affiliation(s)
- David H Saunders
- Department of Physical Education Sport and Leisure Studies, University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ
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van de Port IGL, Wevers L, Roelse H, van Kats L, Lindeman E, Kwakkel G. Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: the protocol of the FIT-Stroke trial. BMC Neurol 2009; 9:43. [PMID: 19674485 PMCID: PMC2736157 DOI: 10.1186/1471-2377-9-43] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 08/13/2009] [Indexed: 01/19/2023] Open
Abstract
Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life (HRQoL). A key factor in effective stroke rehabilitation is intensive, task-specific training. Recent studies suggest that intensive, patient-tailored training can be organized as a circuit with a series of task-oriented workstations. Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured, progressive task-oriented circuit class training (CCT) programme, compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre. The task-oriented CCT will be applied in groups of 4 to 6 patients. Outcome will be defined in terms of gait and gait-related ADLs after stroke. The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue, anxiety, depression and perceived HRQoL. Methods/design The multicentre single-blinded randomized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation, who are able to communicate and walk at least 10 m without physical, hands-on assistance. After discharge from inpatient rehabilitation, patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre. Control group patients will receive usual individual, face-to-face, physiotherapy. Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after randomisation. Primary outcomes are the mobility part of the Stroke Impact Scale (SIS-3.0) and the EuroQol. Secondary outcomes are the other domains of SIS-3.0, lower limb muscle strength, walking endurance, gait speed, balance, confidence not to fall, instrumental ADL, fatigue, anxiety, depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects, FIT-Stroke will address two key aims. The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy. The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke. Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council. Trial registration This study is registered in the Dutch Trial Register as NTR1534.
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Affiliation(s)
- Ingrid G L van de Port
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
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Wevers L, van de Port I, Vermue M, Mead G, Kwakkel G. Effects of Task-Oriented Circuit Class Training on Walking Competency After Stroke. Stroke 2009; 40:2450-9. [DOI: 10.1161/strokeaha.108.541946] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lotte Wevers
- From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France
| | - Ingrid van de Port
- From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France
| | - Mathijs Vermue
- From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France
| | - Gillian Mead
- From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France
| | - Gert Kwakkel
- From the Center of Excellence for Rehabilitation Medicine Utrecht (L.W., I.v.d.P., G.K.), Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands; the Department of Neurology and Neurosurgery (L.W., I.v.d.P., M.V., G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; VU University Medical Center, the Department of Rehabilitation Medicine (G.K.), Amsterdam, The Netherlands; and the University of Edinburgh (G.M.), Royal Infirmary, Little France
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Elson T, English C, Hillier S. How much physical activity do people recovering from stroke do during physiotherapy sessions? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.2.38893] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tony Elson
- School of Health Sciences, University of South Australia, Australia
| | - Coralie English
- School of Health Sciences, University of South Australia, Australia
| | - Susan Hillier
- School of Health Sciences, University of South Australia, Australia
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English C, Hillier SL. Circuit class therapy for improving mobility after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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English C, Hillier S, Stiller K. Incidence and severity of shoulder pain does not increase with the use of circuit class therapy during inpatient stroke rehabilitation: a controlled trial. ACTA ACUST UNITED AC 2008; 54:41-6. [PMID: 18298358 DOI: 10.1016/s0004-9514(08)70065-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
QUESTIONS Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control? DESIGN Controlled trial with intention-to-treat analysis. PARTICIPANTS Sixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke. INTERVENTION Participants received either individual therapy or group circuit class therapy. OUTCOME MEASURES Incidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, Week 4, and discharge. RESULTS There was no greater chance of participants receiving circuit class therapy having shoulder pain at Week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving individual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at Week 4 (mean difference -0.2 cm, 95% CI -3.2 to 2.7) or discharge (mean difference -2.1 cm, 95% CI -4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at Week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control. CONCLUSION The incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation.
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Affiliation(s)
- Coralie English
- University of South Australia, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
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Blennerhassett J. The value of circuit classes in stroke rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.6.29445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
I write with reference to the article Patient Satisfaction with circuit class therapy and individual physiotherapy (vol 15(4), 2008, p.167). Circuit classes of task-related practice have become a popular means to enhance patient practice during stroke rehabilitation (Blennerhassett and Dite, 2004; Salbach et al, 2004; English et al, 2007). The organization and supervision provided in these classes enables patients to increase the amount of practice of relevant functional skills that are tailored to the individual's ability. Stroke patients who participate in circuit class therapy as a sole therapy (Salbach et al, 2004; English et al, 2007) or in conjunction with individual therapy (Blennerhassett and Dite, 2004) make statistically signifi cant and clinically meaningful gains in walking (Blennerhassett and Dite, 2004; Salbach et al, 2004; English et al, 2007) and upper limb ability (Blennerhassett and Dite, 2004; Salbach et al, 2004). Circuit classes of task-related practice therefore seem to offer a practical and efficient use of health-care resources to optimize patient outcome during stroke rehabilitation.
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Lynch E, Harling R, English C, Stiller K. Patient satisfaction with circuit class therapy and individual physiotherapy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.4.29035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this observational study was to determine patients' levels of satisfaction with circuit class therapy and individual physiotherapy sessions on a stroke rehabilitation unit. Forty-nine persons participated in both circuit class therapy and individual physiotherapy sessions as part of standard inpatient rehabilitation following stroke. A purpose-designed questionnaire was administered to investigate patient satisfaction. High degrees of satisfaction were reported with both methods of physiotherapy service delivery. Individual sessions were perceived as being more tailored to participants' goals, whereas participants reported that circuit classes offered a more supportive environment than the individual therapy sessions. Participants were satisfied with the amount of supervision and assistance provided in both forms of physiotherapy service delivery. No distinct advantage was seen for one form of therapy over the other in terms of patient satisfaction.
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Zanker K, English C, Prideaux N, Luker J. Interdisciplinary circuit class therapy: Increasing therapy time on an acute stroke unit. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2007. [DOI: 10.12968/ijtr.2007.14.11.27597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Zanker
- Flinders Medical Centre, Bedford Park, South Australia, 5042
| | | | - Nicole Prideaux
- ANCER Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042
| | - Julie Luker
- ANCER Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042
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English C. Circuit class therapy versus one-to-one therapy sessions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2007. [DOI: 10.12968/ijtr.2007.14.5.23536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Coralie English
- Physiotherapy, School of Health Sciences, University of South Australia, North Terrace, Adelaide South Australia 5000
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